Getting cocaine out of the system is best done in an environment that is properly supervised and includes a medically assisted detox. The presence of medical and psychological experts and well-trained staff who will oversee and monitor the drug rehab process will hasten recovery and ensure that the individual is safe and support is always available.
What you should know about cocaine
Cocaine addiction affects not only the addict, but also the family and friends, and the community in general. In a 2010 study, heroin and cocaine were found to be the most harmful drugs in the UK. (1)
Cocaine is also one of the hardest drugs to quit. As a stimulant, it increases dopamine production in the brain, giving the user an immediate but short-lived feeling of euphoria. Aside from the pleasure it gives, users are partial to cocaine because the effect comes quickly, the user feels self-confident and becomes energetic, it makes them mentally alert and it decreases fatigue.
As usage progresses, tolerance develops, and the user will need more of the substance to experience the desired effects. When using cocaine becomes chronic, is beyond control and dose is continually increasing, negative behavioural consequences appear.
Euphoria becomes excitability and restlessness, and mental alertness gives way to paranoia, aggression and hallucinations. It is not uncommon for cocaine addicts to display violent behaviour that could harm them and other people, and lead to legal troubles.
A NIDA survey found that 68 percent of cocaine users use crack cocaine, which is cheaper and faster-acting, and they are taking other drugs as well. Users seek treatment for addiction when behaviour becomes unmanageable, psychological symptoms are present or social and legal issues arise.
How cocaine addiction is treated
Getting coke out of the system safely involves detoxification and the consequent withdrawal management. A cocaine detox alone is usually not effective as a long-term treatment. Its purpose is to stabilise the physical body to prepare it for a broader set of interventions with the goal of preventing a relapse and maintaining sobriety.
Detoxification is the first step in any cocaine addiction recovery programme. It is the planned process of purging the drug from the user’s system until all traces of it are gone. A cocaine-free body is essential as the first step of the cocaine addiction recovery programme.
Unlike other drug addictions, the US Food and Drug Administration and the UK Mental Healthcare Regulatory Agency have not approved any medication to substitute for cocaine during detox. However, physicians may prescribe medication for symptomatic relief on an individual basis.
- A professional assessment prior to starting the detox includes:
- Amount of cocaine used each time
- Method of use (snorting, smoking, injecting)
- Duration and frequency of use
- Age at start of use and current age
- Concurrent use of other drugs
- Weight, genetics, metabolism
- Presence of other medical illness or psychiatric disorder
The withdrawal timeline and severity of symptoms will vary from one person to another based on the above information.
The Withdrawal Syndrome
Withdrawal symptoms are unavoidable in cocaine detoxification. Since cocaine is a short-acting stimulant, withdrawal symptoms may appear as early as two hours or if three days after last use.
If the method of ingestion is smoking or injecting, effects will be felt after 5-10 minutes; if cocaine is snorted, it will take 15 to 30 minutes to feel the effects(2).
Withdrawal is a scary and unpleasant stage in the overall treatment program. The common signs and symptoms of stimulant withdrawal, as described in a publication from a US National Institutes of Health (3) agency, are:
- Thin, gaunt appearance
- Fatigue, lethargy, low mental and physical energy
- Dulled intellectual and cognitive functions
- Agitation leading to listlessness
- Increased hunger
- Erratic sleeping patterns
- A mood of generalized dissatisfaction leading to depression and suicidal thoughts
- Continuous and intense craving for the drug
- Anxiety, irritability
- Loss of interest in activities once enjoyed
- Memory impairment
- Withdrawal from family and friends
An earlier study of cocaine withdrawal (Gawin and Kleber, 1986) described three distinct phases that the individual goes through: the “crash”, “withdrawal” and “extinction”.
Phase one is the crash. In withdrawal, it occurs within 24 hours after cessation of use and may last up to 7-10 days. It is characterized by fatigue, anxiety, irritability, sadness, extreme depression, desire for sleep, and suicidal ideations.
Phase two is the withdrawal stage. After the crash, this phase sets in and can last up to 10 weeks. The dysphoria, anxiety and depression are still present, but moods start to change, and paranoia may begin.
Irregular sleep patterns will drive the individual to use alcohol, marijuana, or benzodiazepines to help them sleep longer, and the cravings for the drug intensify, making this phase highly risky for a relapse.
Phase three, the extinction, may last for six months. The craving for cocaine appears at changeable intervals and mood swings persist.
But these are not clear-cut patterns and deviations may happen, as later studies (Lago and Kosten, 1994; West and Gossop, 1994) show. Cocaine withdrawal symptoms can be mild in some users and severe in others. When considering rehab treatment, many factors are taken into consideration, such as severity of addiction, economic and other circumstances, and social support available.
How long does cocaine stay in the system?
Tests will show if cocaine is still in the system. In a blood or saliva test, it is typically present for up to 2 days. A urine test will show cocaine up to 3 days and up to 2 weeks on heavy users. In a hair test, it can stay for months to years.
Most drug and alcohol addiction recovery facilities offer cocaine detox in inpatient and outpatient rehab settings.
Quitting cocaine may have serious or fatal consequences. The patient will experience withdrawal symptoms like anxiety, restlessness, depression, and insomnia.
Therein lies the danger of a DIY detox. Individuals attempting a detox at home do not have adequate knowledge about the science behind the process. Without the help of medical expertise to manage withdrawal symptoms, the patient might resort to suicide attempts or give in to the cravings and have a relapse.
The dangers of doing an at-home unassisted detox
Many users have attempted to detox at home without assistance from professional rehab centres, medical doctors or counsellors. Common reasons for at home unassisted detox are the costs of professional detox, fear of embarrassment or humiliation, and thinking that willpower alone is enough for a successful detox.
But the harsh truth is, unsupervised home detox is dangerous and may lead to dire and fatal consequences. A psychotic episode of a young man was attributed to his use of a DIY home detox kit.
The risks of an at-home detox include the following:
1.) Adverse behaviour issues
In cocaine use, the dopamine in the brain is abnormally high, leading to euphoria. In an ongoing detox, when the brain is deprived of cocaine, the dopamine level decreases. This causes the individual to become depressed and agitated, resulting in suicidal thoughts or violent behaviour.
2.) No access to medications to alleviate withdrawal symptoms
At-home detox does not provide the support of medical interventions that doctors can prescribe to ease the anxiety, depression and insomnia that are effects of cocaine withdrawal.
While no drug has been approved for use in cocaine detox, certain medications such as propranolol, trazodone and modafinil, may be given to reduce anxiety and depression. Benadryl is prescribed to counteract the insomnia that detox causes.
Medications for these symptoms that are sold over the counter have low strength to make them safe for use without a doctor’s prescription. But this low strength is not enough to counteract severe withdrawal symptoms and will not be effective.
3.) The high likelihood of relapse
The relapse rate in cocaine addiction treatment is 40% to 60% (4). Relapse happens during withdrawal when the physical and mental symptoms, and cravings are so intense that using cocaine again is the only way to relieve them.
Without the medical and psychological support of professional rehab treatments, individuals trying at-home detox give in and suffer a relapse.
In an at-home detox, the lack of proper management of withdrawal symptoms causes a relapse. Unfortunately, the brain has been recalibrated during detox and the body now needs a higher dose of cocaine to feel its effects. In an overdose, consequences can be fatal.
Inpatient vs Outpatient Rehab for Cocaine Addiction
In any drug addiction recovery programme, the patient or his family has the option of choosing between inpatient or outpatient rehab. Here are the common differences between the two:
Choosing inpatient rehab
Before choosing inpatient rehab, plans for the changes in living arrangements at home must be made and the employer must be informed. Important affairs must be settled first so that upon admission, the patient is able to focus on the recovery programme wholeheartedly.
Most inpatient rehab programmes last from 30 to 90 days.
They follow a well-structured schedule that include spiritual activities, physical wellness programmes, one on one and community group therapies. Sleep and wake up times are part of the organized routine. Some facilities include family counselling during the inpatient recovery period.
The first step in inpatient rehab is the detoxification process. Getting cocaine out of the system usually takes 7-10 days but may take shorter or longer depending on factors like the patient’s weight, amount taken, frequency of use, and metabolism. Withdrawal symptoms appear in varying degrees and the urge for cocaine is strong.
The advantages of inpatient treatment are the 24-hour presence of psychologists, counsellors, and psychiatrists to help and support, intensive science-based treatment, and absence of external stressors. The biggest drawback is the high cost for room and board, and 24/7 medical support.
Since detox is purely a physical process, the patient’s vital signs and health are constantly monitored. Medications are prescribed for relief of symptoms. Although no medication is not yet approved for cocaine withdrawal per se, propanolol, a cardiovascular drug for hypertension and angina, is prescribed to treat anxiety. Other medications for stabilising moods and lowering anxiety are given if these symptoms last for more than 7-10 days.
An inpatient rehab setting, where sufficient monitoring and medical assistance is always available, is recommended to ensure the individual and others’ safety. Personnel in rehab facilities are aware of these dangers and are sensitive to changes in the patient’s moods and behaviour.
Choosing outpatient rehab
When choosing outpatient rehab for cocaine addiction if the addiction is mild or financial and employment circumstances are not favourable for an inpatient treatment. This type of recovery programme will require the individual to visit the facility for 10 to 12 hours a week for 3 to six months.
In outpatient rehab, the patient has drug abuse education sessions, and one on one or group counselling. The programme is not as restrictive and will allow the individual to carry on with daily normal activities and continue working. These are usually scheduled in the early mornings or nights to allow the patients to go on with their daily activities or jobs.
The disadvantages to outpatient treatment are the limited availability of medical and psychological care in case of severe withdrawal symptoms, possible lack of family support, and accessibility to drugs if cravings are too strong to resist.
Before starting a medically assisted outpatient detox, the individual must go through a physical and mental examination in a hospital or at the rehab facility. A doctor may prescribe medications to relieve withdrawal symptoms like anxiety, insomnia, depression, or increased heart rate. Outpatient detox typically lasts 6.5 days.
Groups that make use of the 12-step programme are helpful in providing additional support for addicts in outpatient rehab. Joining groups like Alcoholics Anonymous and Narcotics Anonymous may be incorporated into the outpatient treatment to help recovering individuals avoid a relapse and stay sober. Outpatient treatment may also be a continuation of a completed inpatient rehab.
Both inpatient and outpatient treatments have their advantages and drawbacks. Whatever choice is made, cocaine addiction rehab is the only way to get one’s life back. Getting cocaine out of the system is the first step in a lifelong recovery process that will include medical and supportive interventions.
For a comprehensive and properly supervised cocaine rehab Gloucester in the UK has private rehab clinics that are managed by top medical specialists and compassionate personnel who will guide the patients to a safe recovery from admission to discharge.